Wednesday, September 3, 2014

MRI Results + The Future


Relevant Plot Points:

  • On-&-off hip(ish) pain since late July, identical to what I was having last summer leading up to spectacularly crippling myself at M2B marathon.
  • Since then, lots of missed workouts/general suckage.
  • Friday before Santa Rosa Marathon, my doctor ordered an MRI & made me promise to quit the race if I had any pain & then not run at all after that until we find the problem.
  • I started the race but felt sort of tight/"off" with my stride & dutifully stopped at mile 15 when it was clear I'd be risking a bigger injury for a non-PR race. (Race report = here.)

All caught up?

So. I had the MRI last Friday, which was noisy & took a while but was otherwise uneventful. (I didn't have any claustrophobia issues but I TOTALLY see how someone could if that's your particular bugaboo. It is a bit like being in a really noisy white plastic coffin.) On Tuesday the doctor called me back to say that it showed a tiny, very fine not-quite-crack on my right ischium, which was one I had to look up:

It wasn't advanced enough to call a stress fracture, but was clearly a stress reaction of some kind and probably would have headed in that direction had I tried to run through it. As for the cause, well, you get them from any one or more of the same list of 20 things that cause every other running injury on the planet, which means god only knows. Apparently, even though the reaction is in that one bone, pain in the glutes, groin, adductors, hip flexors, lower back and sometimes thigh or even knee as a result is fairly common, all of which I've had at some point in the last 1.5 years. (Apparently pelvic stress fractures are commonly mistaken for adductor strains since that's where those muscles insert, which explains A LOT.)

The good news:

  • We have some clue about what was causing the pain.
  • The damage is very, very minor and should completely heal in a few weeks (whereas full-blown pelvic stress fractures can take 3-12 months of zero impact to heal, depending on the severity).
  • I can still run on it while it heals as long as I keep the volume low, don't do any speed work, and stop if there is any pain with impact. (Currently there isn't.)

The bad news:

  • The stress reaction is still a symptom, not the root cause.
  • I am probably headed back to physical therapy to try to figure out & address said root cause, which could be just about anything related to moving my body.

One more bit of good news is that I have a RunSafe appointment at UCSF booked at the end of September, so if there is something to be found biomechanically, they should be able to find it.


As disappointing as it was not to be able to run Santa Rosa the way I wanted, having the whole thing over and done with brought with it an enormous sense of relief. Ever since the issue with my hip returned after SF2HM, running has been so stressful. I haven't really been able to enjoy it because even when I've been pain-free, it's been with the stress of August 24th bearing down on me & the constant fear of the pain coming back and/or finishing the race in the same shape as after M2B. Training is supposed to be (mostly) fun & races are supposed to be exciting, but it's hard to have fun with something when you're constantly worrying about it. On Saturday before I left for the race, I said to Don, "Twenty-four more hours & one way or another, all of this will be over." So you can maybe tell what my mindset about it has been for the last few weeks.

And now it's over. I only ran 16.5 miles (btw, it's pretty entertaining to tell non-runners you "only" ran 16.5 miles, heh) so I didn't have the usual post-marathon physical exhaustion to deal with. Mentally, though, I've been Jello this past week, as if something in my brain went, "Look, we got you through that crap, and now that it's over, we are DONE."

That week saw one bike ride and one karate class, but other than that I've been a complete slacker. I worked at home (read: slept in) most days or went in late/left early, spent hours sitting on the couch reading, and happily abandoned any pretense of eating like an athlete. I read almost no blogs and looked at almost nothing running related. In short, I essentially detoxed myself of all things running, which was exactly what my brain needed.

That week also gave me some time to reflect back on my training cycle and think objectively about it. DNF nonwithstanding, I think I learned a lot and accomplished a lot in those 15 weeks.

For one, I'm proud to say that not once did I miss a workout for a cop-out reason. Yes, I had trouble with my hip (11 workouts) & Achilles (2 workouts), got sick a couple times (2 workouts), had a couple of super-packed travel days (2 workouts), and took a few extra rest days when I was concerned about overdoing things (6 workouts), but not once did I ever say, "Eh, I'm just too busy/tired/not feeling it." Not once. I think this may be the first training cycle where I've really been able to say that.

Also, with the exception of the weeks when I was traveling & the week before the race (where I was busy mentally self-destructing), I've been consistent with my strength work. I think it'll be good to get re-assessed at the PT and/or RunSafe to make sure I'm still doing the right things with the right frequency, but up until that last week, I did not slack.

There were also some bright points to starting & running a good chunk of the race. For one, it gave me some additional practice with managing marathon logistics like clothes, packing, fueling, the whole pre-race routine, etc. I feel like I've run enough 5K/10K/halfs to have all that down for shorter races, but since I run marathons so rarely, it's not something I get a ton of practice with.

For another, the fact that I was in okay/not bad marathon shape, ran 16.5 miles, & then stopped means that at this point, I'm still sitting on a pretty solid base without having wrecked my body. Yes, a lot will depend on how the next month goes, but there exists at least the possibility that in the not-too-distant future I might be able to start training for something farther out with a solid base already in place. (Which, hey! Wouldn't that be novel!)

Obviously, it's too early to start setting any specific running-related goals. But, being a pretty goal-driven person, I can only lounge on the couch with my books and my wine for so long before I need SOME sort of target in my life, if only a small, short-term one. So until I can get back to thinking about racing and training, I have two (I think) very reasonable, very achievable goals for the month of September:

1) Get to RunSafe as healthy, fit, & strong as possible. These appointments are not cheap and I want to be sure I get everything I can out of it. To that end...

  • Be very careful with the hip/stress reaction. I want to do some non-trivial running over these next few weeks since the doctor okay'd it, but never at the expensive of letting the injury heal.
  • Get as strong as possible. Like I said, I was incredibly consistent with the strength work this summer up until the end of July, so I'm still pretty strong. But if I go in with the same weaknesses and imbalances that I already know I'm prone to, they're only going to be able to tell me things I already know. I want to know what's wrong when I'm at my absolute best.
  • Get reasonably lean. Again, I think I was in my best shape at the end of July, but I never managed this summer to really get to what I think of as racing weight/body composition, and since then all the missed workouts/lack of strength work/emotional sabotage/week of mental recovery hasn't helped. September seems like a nice, chill month to focus on that & try to get back into really good shape before I start training for something again.

2) Maintain the fitness (at least in terms of endurance) I've developed over the summer.

  • As long as my leg stays pain-free, try to do longer runs with more rest days rather than shorter runs more frequently. (The priority, though, is taking care of my leg.)
  • Supplement with time on the bike (particularly short, fast intervals) when I can stomach it. Gaaaaaaaahh...

I am not as strong now as I was at the end of July, but I still have a respectable level of endurance, & if I can hold onto that until I'm ready to pick a race & start training again, I'll be in a much better place than I was in May.

AND FINALLY, because the universe must always maintain a balance between the sucky & the delightful, get thee to White Rock Vineyards in Napa & stock up on some of this.

Quite possibly the best chardonnay I've ever had in my life, and that's coming from someone who generally *loathes* California chardonnay. Amazing.


  1. Nice catch early. This could be way worse! And I do hope you can get some good information out of RunSafe or the PT. I feel like *something* is always off in my hips/pelvis, and OMG I do not want chronic injuries! So the sooner you figure it out and work on it, the better. You've played this whole training cycle smart, or you'd be in much worse shape, so I am sure you'll continue to make good choices.

  2. Ugh. Darn it. But yes, well done for stopping running early and for catching the stress fracture early as well. (I'm sure this has been mentioned before and you'd checked it but have you had your bone density looked at lately?). I'm so frustrated for you though.

    1. I haven't specifically had a bone density test, just because my twice yearly blood panels have always shown that my calcium & vitamin D looked good, & if your bone density is messed up they just tell you to exercise more & take more calcium / D anyway. :P

      But hey, I suppose it doesn't hurt to ask when I see the doctor again...

  3. Good on you for stopping early, and the whole general long-term planning mindset. There's probably no magic bullet re: figuring out what is wrong with you ('do this 1 magic exercise and your form will improve and you'll be injury-free!'...nope, running doesn't work that way). But I hope RunSafe or physio has some more answers.

    I forget if you have convenient pool access - can you pool-run?

    1. Well, he says I can run right now as long as there's no pain, so I'm just trying to keep it at like 3 days per week for now. So hopefully I can avoid the pool running!

  4. I'm glad you know what it is and how to deal with it. I hope your PT finds out why it's happening - once you've got that sorted you'll be able to manage your training so much better without fear of recurrence.

  5. Sorry to hear about this, but glad you caught it early. Curious to see what RunSafe will reveal -- hopefully some answers that will lead to speedy healing and prevention of future problems. Sending good thoughts! (Although you'd probably prefer wine instead. Ha.)

    1. Thanks!

      (But yes, if you feel inclined to send wine...... ;) )

  6. Yeah, you totally earned the right to "wine" a little.
    Boo for stress reactions, but at least you have a diagnosis. That not knowing deal is so frustrating.
    Glad you're on the mend... Again.
    Also, you must be a boss at MRIs - I'm not claustrophobic either, but I kept thinking it was trying to hurt me.

    1. Heh, well, the ear plugs helped a lot. I can't imagine how loud it would be otherwise.

  7. Crossing my fingers for a conclusive "cure" for your troubles and pain-free training in your future!

    1. Thanks!

      I swear one of these days I am going to be healthy / not traveling long enough to get a trail run in with you ladies!!

  8. I'm so glad it's something heal-able and that you have an answer to some questions. I hope it heals quickly and thoroughly and that you're also able to figure out the root cause and a future prevention plan. I hope it's better in time for Jingle Bell Hell. You and Jen need to square off...determine who is the true champion ;-)

  9. Oh no. Just seems like you have battled the doctors for a long time now off an on. Hopefully you are able to cure this and stay out of the doctors office permanently.